IRS Project to Combat Malaria in Lake Zone

Nashon Kennedy | 04 Oct 2010
Tanzania Daily News
Mwanza — Malaria remains a serious pandemic, affecting some parts of the world including the Eastern and Central Africa and continue to claim lives of millions of people. It is a major Public health problem for the Sub-Saharan Africa countries.

About one million people are dying annually and more than 400 million cases of malaria reported every year. It also causes one third of deaths among children under five years of age. According to the HIV/Malaria Indicator Survey for 2008/09, the disease is the leading cause of morbidity and mortality among outpatient and inpatient admissions in Tanzania.

It accounts for up to 40 per cent of all outpatient attendances in the country. Many parts of the mainland, including the uplands, report malaria transmissions throughout the year although it occurs more frequently during and after rainy season. Malaria pandemic is caused by four species of plasmodia parasites that are transmitted by Anopheles mosquitoes.

Plasmodium falciparum is the most common for the transmission of the disease. It causes severe malaria, and is fatal if not diognised promptly and properly managed. The most severe cases occur among persons who have not yet developed sufficient immunity to malaria through previous exposure. Children under five years of age are at highest risk, followed by pregnant women because of their reduced natural immunity levels, where one fifth of deaths reported are of the pregnant women.

Malaria causes loss and economic burden in the country, ranging from school nonattendance to low productivity at workplaces. It also reduces agricultural production and other economic output; additionally, the accumulated effect in the long term may decrease national economic capacity and development.

In Mwanza region, it contributes to 39.4 per cent and 48 per cent of all outpatient attendances in less than 5 yrs and above 5yrs of age. It also contributes to 33.4 per cent of children under five and 42.1 per cent for 5 yrs and above of all admissions in health centres.

Mwanza Region Commissioner (RC) Abbas Kandoro says the disease killed more than 1500 people in 2009.

The Regional Commissioner says that most of the people who attended to the health centres were found to be infected with the disease. "Over 1.3 million malaria cases were reported at various health centres in the region, out of those 61,866 were admitted, and 1662 died, and out of those who died, 754 were children under five of age," he says.

He says it was absurd hearing such a big number of children under five dying of the otherwise preventable and treatable disease. He says the statistics shoulders big challenge to Mwanza authorities and residents on ways to controlling the diseases. "It also irks to learn that most of mosquito nets which are provided by various donors and parties for malaria control efforts are misused.

Some people are using this mosquito prevention intervention for fishing. It is absolutely unacceptable," he said calling on lake zone residents to do away with this shameful practice. Much effort in controlling the disease made by various NGOs, CBOs, and the government itself are being hampered by a few individuals who misuse the nets.

It is no doubt that the government through the Ministry of Health and Social Welfare is committed to the control and prevention of malaria. One of the organizations involved in the fight against the pandemic through research efforts is the Research Triangle Institute (RTI International) which is an independent organization that is dedicated to carrying out the innovative research to improve human condition in the country.

According to the RTI International Zone Manager, Dr Pius Tubeti The United States Agency for International Development (USAID), under the Presidents Malaria Initiatives (PMI), awarded RTI International a cooperative agreement to work with the National Malaria Controll Programme (NMCP) and the Zanzibar Malaria Control Programme (ZMCP) to implement the Indoor Residual Spraying (IRS) and other malaria control and preventive activities in Tanzania Mainland and Zanzibar respectively.

"RTI assisted ZMCP with its IRS project in 2006 that enabled it achieve a high coverage of 96 per cent (of sprayed households) and lead to a significant drop in malaria cases in the Isles", says Dr Tubeti He says based on Zanzibar results, the NMCP requested RTI International to assist in conducting IRS in Kagera Region in 2007, where it was sprayed to over 90 per cent of households and managed to prevent malaria epidemics which used to occur very frequently.

"After the use of IRS, the malaria cases in Kagera region also decreased significantly", he says. He said due to the achievements, the Project which has now been given a new name of 'the Tanzania Vector Control Scale Up Project,' was being implemented in Mara and Mwanza regions, in the Lake Zone.

The project according to him will have three components of malaria control, which are proper diagnosis and management of malaria cases, distribution and use of Insecticide Treated Nets (ITN) and Indoor Residual Spraying (IRS) in targeted population which works for between 6 to 9 months and involves spraying of household walls. He says the IRS, was a five years project, which will cover Lake Zone regions of Mara and Mwanza.

The project will start with three districts in Mwanza regions in the first phase, namely Kwimba, Magu and Misungwi. The Project Technical Advisor from the ministry, Dr Fabrizio Molten, says that the main mission of the project is to progress from malaria control to elimination. "Our immediate goal is to reduce by 50 per cent the number of malaria cases (estimated at 12 million annually) and deaths (estimated to be 60,000- 80,000 annually) by 2010," he says.

According to him, the next target will be to scale up both reduction of cases and deaths by 80 per cent by 2013 and progress from malaria control to malaria pre-elimination and elimination. He says among strategies to be deployed as stated earlier include the Indoor Residual Spraying which is the application of the long-lasting chemical insecticides on the walls and ceiling of all houses in the three districts, in Mwanza region.

He said during the operation, Kwimba will have 10 sites, Magu 12 sites and Missungwi will have eight sites and about 9bn/- will be spent in this endeavour. He says they settled for IRS because it was safe for human and environment ecology, its efficacy and cost -effectiveness, and had put into consideration the mosquito resting behaviour which is in walls and ceilings.

He says in areas where the project had been implemented, before IRS, 75-80 per cent admissions in paediatric ward were due to malaria, but three years after the introduction of IRS, only one out of six children admitted were diagnosed of malaria. He says the impact of IRS shown in Zanzibar in two districts of Micheweni and North 'A' indicated that, in 2003 before the project, malaria prevalence reached to 14 per cent and after last year after the project it dropped to 0.07 per cent.

"Also the positive effect of Indoor Residual Spraying has been noted in Kagera Region, where in some areas such as Muleba , the proportion of patients attending hospitals with malaria dropped from an average of 40 per cent before IRS to less than 10 per cent after the use of IRS," he says adding that children with severe life threatening anaemia, that received blood transfusion decreased from an average of 2000 per year before IRS to 500 per year after IRS.

He urged residents in the three districts where IRS will be introduced in Mwanza to accord cooperation to the health experts and follow the instruction to achieve good results. He says, in the three districts of Mwanza region,a total of 417,639 household will be reached and 13,051kilogrammes of insecticides will be used. Community leaders will work hand in gloves with our experts and about 1,406 pumps and 184 vehicles, will be deployed at the excercise.

He said 142 vehicles will be used by operators and 42 by supervisors, and seminars for the exercise have already started. IRS project in the area was expected to employ 3,463 temporary staffers, where 2,272 will be operators, 284 team leaders, 142 Supervisors, 71 managers and 694 others who will be assisting during the spraying activities in the households. Mwanza Regional Medical Officer (RMO) Dr Meshack Massi says the project has come at the right time since the area had alarming figures of illness and deaths related to Malaria.

He says a total of 802,400 malaria cases for the children under five years were reported in the region last year. According to the RMO, in Mwanza City alone a total of 159,682 malaria cases of children under five years were reported, while in Magu there were 68,100 cases, Ukerewe (50,205), Kwimba (49,154), Misungwi (89,049), Sengerema (125,702) and Geita (260,508) Dr Massi says that 1600 people died of malaria in the region last year.